Alcohol and the hypothalamic-pituitary-adrenal axis

For more than two decades, endocrinologists have known that alcohol abuse alters the dynamics of the hypothalamic-pituitary-adrenal (HPA) axis. Acutely, ethanol ingestion may stimulate a rise in plasma ACTH and cortisol levels. Chronic alcohol abuse is associated with activation of the HPA axis and resistance to dexamethasone administration, especially during periods of acute withdrawal from alcohol. However, on completion of withdrawal from alcohol, the HPA axis has a period of dampened responsiveness. In fact, some actively drinking alcoholics meet the criteria for centrally mediated adrenal insufficiency.